So you're GBS+? Now what? What should you do (or not do) to prevent infection?

Here are some general tips to consider. Remember, I'm still not a doctor or a lawyer...ask your birth professional for more information and educate yourself - read and decide for yourself if the information I present is valid!

Tips for GBS+ moms: (These are generally geared toward moms WITHOUT a previous history of GBS complications, but they work for most GBS moms.)

1) Consider a URINE screen for GBS during pregnancy. GBS in the urine indicates a higher risk of infection in baby since it correlates with high levels of GBS in the vagina. GBS urinary tract infections (u.t.i.s) are often asymtomatic, so you might not know it's there. Testing the urine for GBS is the only way to know if it's present. GBS in the urine has been linked to preterm labor/delivery, premature rupture of membranes. It is very important to get rid of GBS in the urine immediately.

If you have preterm labor, this might be a result of u.t.i. - get a urine screen if you've had preterm labor (in any pregnancy) and insist on oral antibiotics immediately if there is GBS in the urine. You'll still need IV antibiotics in labor, even if the labor stops and the u.t.i. is cleared.

2) A c-section DOES NOT automatically reduce the likelihood of infecting baby, since the bacteria can still infect baby when the womb is opened. Chances of infection are a bit lower for baby after a c-section, but mom is more likely to have serious complications from GBS from a c-section. GBS causes 50,000 maternal post-cesarian infections each year in the US. Just being a GBS carrier is not enough reason to have a c-section.

3) There is NO need to induce a mom who is GBS+ and has had no complications just so she can get enough antibiotics. If you are term and haven't had any risk factors, the antibiotics can be effective in as little as 15-30 minutes.

Four hours or more of IV antibiotics are recommended as a guideline for doctors. If you get ANY antibiotics they can help, but more is better in most cases. Get the antibiotics as soon as it's reasonable to get to the hospital.

If you're concerned about a fast labor, be reassured -- faster labor is actually better -- babies whose moms had fast labors at term are LESS likely to be infected.

If you have a risk factor BEFORE the IV antibiotics are started, it takes more time to fight the infection and baby MIGHT still get sick, even after treatment. This is why it's important to get IV antibiotics in early labor - before risk factors can occur.

4) Avoid internal monitoring in labor. The internal probe actually creates a small scrape on baby's head where the bacteria can get into the bloodstream. Internal monitoring is NOT recommended for GBS+ moms.

5) Avoid excessive digital exams in labor. The more times you put something in the vagina, the more chance of pushing the bacteria up to baby. Also, douching is a bad idea if you're GBS+. Some homeopaths recommend garlic douches to get rid of the bacteria -- this is a BAD IDEA!

6) Don't allow the provider to rupture membranes to get labor started. The membranes are a barrier between baby and the bacteria, and rupturing them too early puts you on a schedule for delivery and increases the chance of prolonged rupture (a risk factor). Rupturing membranes AFTER the IV antibiotics are started LATE in labor does not seem to be as problematic.

7) Talk to the birth provider about his/her prevention strategy. If you're using an OB/CNM, s/he should offer to start IV penicillin (not ampicillin) or clindamycin (if allergic to pen.) in early labor and continue it until delivery. You can ask for a Heparin or saline "locked" IV, and still have an unmedicated birth if that's your goal. The antibiotics can be given in just a few minutes every four hours, and the rest of the time you can walk, move around, whatever you choose.

If you're birthing at home or at a birthing center, ask if they are able to give IV antibiotics and what they'll do if you develop risk factors (send you to the hospital, etc.).

8) Antibiotics BEFORE labor are not recommended EXCEPT for treatment of GBS u.t.i. Taking oral antibiotics BEFORE labor to get rid of VAGINAL GBS colonization (as opposed to u.t.i.) will not reduce the risk to baby - they might actually increase the chances of creating a resistant bacteria. IV antibiotics in labor are the only proven way to protect baby and they work when baby is at the highest risk of encountering the bacteria - during labor.

9) Talk with the pediatrician you will use. Advise him that you are are GBS+ and talk about what this means for baby. Baby should be watched for 48 hours or so to be sure all is well, but you should still be able to nurse, change diapers, room in, etc. if baby looks well. A good site for information about the symptoms a sick baby exhibits is:

10) Learn all you can. Informed parents are the best defense against GBS. It's okay to know more than your doctor or birth attendant...in fact, it's not uncommon for GBS moms to educate their providers about GBS prevention.

You are the only parents of your baby, and it's your job to start protecting him NOW. If protecting him means standing up for what's best for you and baby, so be it. Believe me -- you won't care if you've ticked off the doctor if your baby gets sick when it could have been prevented!